Professionalism, Supervision, and Pearls for the PGY1 Resident.
-
Upload
marcella-nickel -
Category
Documents
-
view
215 -
download
0
Transcript of Professionalism, Supervision, and Pearls for the PGY1 Resident.
Professionalism, Supervision, and Pearls for
the PGY1 Resident
Professional
• Definitions– Highly educated– Impressive competence– Autonomy– “Comfortable” salary– Creative and intellectually challenging work– Trust– Strict ethical and moral standards
A doctor
Professional
• Ethical behavior • Confidentiality• A duty not to abandon because of inability to pay • Putting the client’s interests ahead of one’s own• Moral compass• Work ethic and motivation • Willingness to share in the transmission of
professional knowledge and values (like today)• Positive attitude towards the profession
Professionalism
• ACGME Outcome Project– Six Competencies• Patient Care
• Medical Knowledge
• Professionalism
• Interpersonal and Communication Skills
• Systems-based Practice
• Practice-based Learning and Improvement
Professionalism
• ACGME definition:– “Manifested through a commitment to carrying
out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.”
Professionalism
• When is it measured?– Assessments
• Peer (‘360 degree’) evaluations• “On the fly” evaluations (clinical & operative)• By rotation• Annually
Professionalism
• How is it measured?– Duty hour adherence and documentation– Nursing interactions– Patient interactions– Demeanor and dress– Devotion to patient care– Ethical decision making– Contributions to the profession
Professionalism
• The essence of professionalism– Continuous self-improvement– Lifelong learning and a thirst for knowledge
• You must read constantly• You must read systematically• You must master the field• You must read throughout your career
– You must share you own ideas with professional colleagues by teaching, speaking and writing!
Professionalism
• Bad outcomes– Bad patient outcomes are sometimes
unavoidable– Perfection is unobtainable
Supervision
• Main principles of surgical GME• Supervision• Graduated authority and autonomy
• ACGME• Recognition that surgical training is fundamentally
different from non-surgical training
One size fits all!
Supervision
• How is surgical training different?– Close supervision at every training level
• Attending staff• Senior/Chief resident staff
– Defined psychomotor goals for each training level
– Hierarchy
Supervision
• When does supervision apply?– In the operating room
• For the key portion of the procedure• For any portion in which you are not independently
competent
– For ward and ICU procedures• Until you are specifically cleared for independence
– For decision making• Any time you don’t know• Any time you aren’t sure whether you know or not!
Supervision
• How are supervision and hierarchy related?– Acquisition of competence
• Cognitive and procedural
– Graduated autonomy• Experience is the best teacher
– Ethical behavior• Uncompromising excellence in patient care
Fatigue
• Fatigue compromises:– Patient safety– Quality outcomes– Resident health
Fatigue
• Two imperatives:– Regulatory compliance for PGY1s
• 16 hours shift limit ABSOLUTE• 80 hours per week, averaged over 4 weeks• One in 7 days off, averaged over 4 weeks• 8 hour minimum inter-shift break• Direct or on-site supervision (senior resident or
faculty)
– Quality and safety• Self monitoring• Ask for help, don’t drive tired
Fatigue
• Patient hand offs– Teamwork approach shortens shifts– Transfer of knowledge and responsibility is a
chance for dangerous errors and poor outcome
• What to do?– Keep meticulous lists of key information, issues– Leave time for ordered, careful handovers at
each shift change, without distractions– Leverage the electronic medical record
Pearls
• It’s a long program– > 6 year program
• Clinical Neurosurgery– > 36 months– 12 months as Chief Resident
• Neurology (3 months)• Neurointensive care• Neuroscience, Neuropathology, Neuroradiology, INR• Research
– 80 h/wk X 48 months X 3 years = 11,520 h– Training a concert pianist: 10,000 h
Pearls
• Don’t be afraid to ask– Silence is often mistaken for understanding– Ask attendings/senior residents when you
don’t know– It’s OK to say “I don’t know”
• Particularly to patients– Don’t provide wrong information!
– Most of all, remember that sometimes you don’t know when you don’t know…
Pearls
• Prioritize– Who are the sickest patients?
• Emphasize their hand-offs• Re-examine them• Prioritize their care
– Stay organized!– Keep lists– Be practical– Brain surgery is really just common sense…
Pearls
• Prepare for cases: Operating in a protected learning environment is a precious and extraordinary privilege– Be rested– Read about the disease– Study, understand the goals of the operation– Meet the patient if you can